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Cancer As a non-tragedy: How far can a positive attitude go

By Joel Achenbach, The Washington Post

Updated:
04/04/2013 07:32:09 AM EDT

A few weeks ago, I took my mom shopping for a refrigerator to replace the one that had been in the kitchen since the Nixon administration. Pleasantries with the salesman took a more somber turn when he revealed that his wife has breast cancer and is seeking to heal herself solely through the power of prayer. My mom listened attentively, then touched the salesman on the chest and said, authoritatively, "Carrot juice! And blueberries!"

She is a believer in the restorative powers of fruits and vegetables, and of wholesome living more generally. She doesn't reject modern medicine, nor would she seek a miracle cure through prayer or New Age therapies. But she is not someone terribly interested in medicine, or technology in general, preferring to exist in a world that is like the one she grew up in — simple, natural, earthy. She has spent her years outdoors, growing plants, doing landscaping, surrounding herself with flowers. She has often ended the day with a cold beer under the grape arbor in her back yard. The yard is a two-acre botanical wonder where she and my stepfather, Jim, have their nursery, plus a robust garden, productive citrus trees and winding footpaths among native plants and towering trees.

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I called to check on her the other day. After quickly assuring me she was fine, she launched into a prescription for how I might reduce some minor leg pain that's been bothering me: "Point one foot at the North Pole and one foot at the South Pole and bend over and touch the floor," she said.

Though full of medical advice for others, she doesn't talk much about her own illness, and it didn't seem to occur to her to tell the appliance salesman that she, too, has breast cancer, stage 3. Here's the key fact about my mom: She doesn't consider herself sick.

She's the opposite of a hypochondriac, never missing a chance to brag about her unusually good posture and the physical strength that many women her age would envy. She informs doctors that her nickname is Tough Lady. When I asked her if I could write something about her medical situation, she said, "Make sure to include what I tell every doctor: 'I'm not old, and I'm not sick!' "

No question, she has a wonderful attitude, and her sunny disposition if distilled and bottled would be sold in every drugstore on the planet.

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But an objective account of Emily Notestein's health history, and of her attitude toward medicine, would surely note that she has not been a diligent student of her disease and that she showed no interest in seeking aggressive treatment when it first appeared. There is a fine line between optimism and denial. The power of positive thinking goes only so far.

How aggressively we deal with cancer hinges in part on age and whether the disease threatens to truncate a life dramatically or merely lop off some years in the final decade or two. And cancer in a septuagenarian can be more indolent than cancer in a young woman. Thus, an older person like my mother faces a different mental calculation than someone who is in the prime of her life. Cancer at 76 doesn't feel like a tragedy.

My mother first had breast cancer two years ago; she had a lumpectomy and no further treatment. She insisted that she didn't need chemotherapy or radiation or a combination thereof. A plausible scenario is that she was stunned by the high cost of the procedure, and lacked Medicare Part B coverage, because back when she was 65 she felt no need to sign up for something that would be useful only on the very off chance that someday she would have a medical problem. ("I was healthy!" she told me when I pressed her on it.) What's indisputable is that the cancer came back in the same breast.

On my Mom's 76th birthday, in late January, her surgeon performed a mastectomy and also removed 22 lymph nodes.

"Everyone was so nice to me!" Mom said that afternoon, groggy from the outpatient procedure. She didn't feel as if she'd been mutilated. She felt that she'd been the star of the show.

The next week, she heard the pathology report, and it wasn't good: cancer in all 22 nodes, officially stage 3 cancer. The initial chest X-ray showed no tumors in vital organs; a subsequent PET scan also turned up no sign that the cancer had spread beyond the nodes. "It's curable," Mom said, getting right to the point.

She's being treated at a cancer center by an oncologist who has his hands full. Twice during the brief initial consultation, he was summoned from the small examination room by nurses dealing with emergencies.

I asked him if the cancer looked aggressive.

"It has some characteristics of being rapidly acting," he said.

He went through the whole scenario: Chemotherapy for 18 weeks, then radiation for six weeks, then years of hormone therapy. Mom would get a port surgically implanted, then receive three cycles of cytoxan, epirubicin and fluorouracil for nine weeks, followed by three cycles of Taxotere for another nine weeks.

My mother took no notes. I later suggested that she research her disease thoroughly. But whereas I saw a problem to be solved, she saw one to be ignored to the extent humanly possible. Her doctor is the expert; she's the plant lady. She's going to live her normal life, and won't spend time, mentally, in Cancerland.

— — —

All is not as it was, of course. She's slower since the surgery. She's got less "steam," she says.

She hasn't had the easiest life, though her third marriage has lasted nearly four decades now. She was a divorced, single mother by the age of 25, working as a saleswoman at Sears while trying to take care of two semi-feral boys in an old wooden house with a leaky roof. We had some lean years, but my brother and I knew we were loved unconditionally.

My mother inherited a strong work ethic, and remarkable powers of endurance, from her forebears back on the farm in Indiana. Her family didn't have indoor plumbing until she was 12 years old. My grandfather as a boy would plow the fields behind two Belgian draft horses, and would know it was time to come home for supper when his mother hung a sheet in the window. "Tell me about the horses, Dad," my mother would say to my grandfather when he was deep into his 90s and clung to his murky memories as if they were handrails. He and my grandmother both lived nearly a century. So my mother is built to last, if she can just make it through her next challenge.

I can't be sure of this, but she seems to be appreciating the world more than ever. My mother is not a society lady, isn't a member of a club and hasn't been to church in quite a while. But she is interested in everyone and everything. She is egalitarian down to her last molecule. When we went to Wal-Mart, it was hard to make much progress toward the kitchen section because she wanted to greet everyone along the way. She doesn't seem to grasp the concept that the official Wal-Mart greeter is supposed to be an employee, not a customer.

Throughout her life, small pleasures have struck her as marvelous. A sandwich nicely prepared is a cause for rapture. In a field of weeds and rubbish she will see, and rejoice in the miracle of, the lone flower.

"Death holds no terror for me," she always says.

Fear and anxiety are adaptive traits to some degree, and the perpetually sunny disposition may not invariably offer an actuarial advantage. I worry that her rose-colored glasses are blinders. But her attitude makes the process easier on everyone else. That's a form of caregiving. It's a gift from the sick person to those who worry about her.

I called her from Washington after her first round of chemotherapy.

"It was a nonevent!" she reported. "It lasted awhile and I got hungry, so afterward we went to Wendy's and I had a baked potato. It was delicious!"

Chemotherapy, in time, will surely beat her up, and she'll lose her hair, and her melodious singsong voice, her trademark feature, may weaken. But will she ever feel sorry for herself? I don't think she'd know how.

As an analytical person, science-oriented, I find it hard to ignore the medical realities here, but my mother in her congenital sunniness is strangely persuasive. And so I have no choice but to believe her: She's not old, and she's not sick.

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